Better Workforce Design is Crucial to Aged Care Reform

Dr Anita Goh, one of Australia’s premier experts on ageing and neurodegenerative diseases, will be speaking at the 12^th Annual National Dementia & Aged Care Reform Conference in Melbourne, 23 – 25 November 2021. She is a Senior Research Fellow at the National Ageing Research Institute (NARI).

We spoke with Anita on how the Royal Commission will improve the quality of life for older Australians, the barriers to its success, and the challenges presented by younger onset dementia – as well as how better workforce design and increased respect for both paid and informal care workers is fundamental.

Anita, in what major ways do you think the recent Royal Commission recommendations and federal budget will improve quality of life for older Australians? What are the barriers to success?

The Royal Commission really highlighted the failures of our aged care system. It is positive to see robust conversations happening about how to reform Australia’s aged care system and heartening to hear a range of people across all types of disciplines talking about the Royal Commission and what it means for our older population.

The more we talk about the importance of quality aged care, the better! The investment in the recent Federal Budget in aged care was very welcome, and I hope we can work together as a sector to realise the recommendations and cause transformational change in aged care for all Australians.

In terms of the barriers to success, a lot of the Royal Commission’s recommendations centre around the workforce. I think there needs to be strategic thinking about workforce design, and where the workforce will come from. We will need a 70% increase in direct care workers to maintain current staffing levels – and this will rise if the recommended reforms are implemented.  Yes, the recommendations are great in terms of more subsidised training, better work conditions, better pay, better career paths and job security. However, what happens if we can’t fill the positions?  How do we attract and retain the right people, and enough people?

The aged care workforce has a high proportion of international and migrant staff, and current COVID-19 restrictions are affecting this. Also, the recommendations don’t clearly address how we, as a society, can better value aged care work and workers, and thus attract and keep the right workforce.

This requires a societal shift, and whilst the Royal Commission’s recommendations and funding from the Federal Government will go some way to addressing the shortfalls, culture change and societal attitude change towards ageing and aged care work is a little trickier and will take time.

What are the key implications from the Royal Commission for dementia care?

Within the 148 recommendations are 14 key areas with a specific focus on dementia. Almost $230 million was allocated in the Federal Budget towards dementia strategies. There are a lot of implications for dementia care, but the project I will be talking about at the conference directly responds to the recommendations of the Royal Commission for greater provision of home care, and the need to upskill the aged care workforce in specialist dementia care.

An area that the National Ageing Research Institute (NARI) and my work has a focus on is the importance of family or informal carers and addressing their needs. Most people with dementia living in the community (over 90 per cent) rely on an informal carer to support them.

Family carers are typically ageing as well, and have many unmet needs, and are at risk of poor quality of life and health outcomes due to their caring role.  The recommendations of the Royal Commission have key implications for the support of informal carers, recognising their integral role in aged care.  Increased funding to better support family carers is very much needed – and I hope it includes using evidence-based interventions and resources that are culturally appropriate and are easily accessible widely throughout the whole country.

What about people living with younger onset dementia and neurodegenerative diseases – how does it affect them?

The needs of people with younger onset dementia and their family carers have now been investigated by two recent Royal Commissions – the Royal Commission into Aged Care Quality and Safety, and the Royal Commission into Violence, Abuse, Neglect, and Exploitation of People with Disability. Neither of these Royal Commissions devoted major specific attention to the complex experiences and needs of people with younger onset dementia. However, many of the recommendations and themes within them can be generalised and have significant impacts for the people impacted by younger onset dementia.

I recently co-authored an editorial on the eight most pressing priorities for research, policy, service and advocacy to improve outcomes for people living with younger onset dementia and their carers, in collaboration with members of the Australian Younger Onset Dementia Specialist Interest Group, which I co-Chair. The priorities were:

Action 1. Promote pathways to care for timely diagnosis
Action 2. Improve diagnostic accuracy and pathways to research
Action 3. Conceptualise younger onset dementia as a condition causing disability
Action 4. Improve integration of the disability, health, and aged care sectors
Action 5. Invest in telehealth services for equitable and timely access to services
Action 6. Improve diagnosis and management for First Nations People
Action 7. Integrate age-appropriate services for family members within existing systems
Action 8. Enable access to suitable housing

The recommendations of the Royal Commission into Aged Care Quality and Safety and investments by the Federal Government can go a long way to addressing these actions, which provide a roadmap to achieving high quality, accessible, and equitable care of people living with younger onset dementia.

Finally, why are events like the National Dementia & Aged Care Reform Conference so important for the industry?

Conferences are such an efficient way to learn about the latest ideas and research in the field, and about things that I would not normally look into or read about.  I always learn so much from the speakers and the people I meet! I love the opportunity to present my ideas and work to other people, in person, which is different to publishing. It’s a great way of getting feedback and has helped to refine my work and to make it useful.  For example, in academic publishing, my work is reviewed by two or three reviewers and an editor before publishing. At conferences, there is often a room full of people of all types of backgrounds that can comment and ask insightful questions about my work. It is a little scarier, but very worth it!

Don’t miss the opportunity to engage with Dr Anita Goh at the 12^th Annual National Dementia & Aged Care Reform Conference, 23 – 25 November at Crown Melbourne. Find out more here.

More About Dr Anita Goh

 Dr Anita Goh is a clinician researcher and clinical neuropsychologist focusing on cognitive health, mental health and well-being, and quality of life in ageing, with a specialisation in neurodegenerative and psychiatric disorders. She is a senior research fellow at the National Ageing Research Institute (NARI), works at the University of Melbourne, and is an honorary clinician at the Royal Melbourne Hospital. Anita is Chair of the Alzheimer’s Association International Society to Advance Alzheimer’s Research and Treatment Health Policy Group, Co-Chair of the Australian Special Interest Group in Young Onset Dementia, and Australian Association of Gerontology Victorian Division Vice Chair.  She tweets as @dranitagoh and can be found on LinkedIN.